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Senate Healthcare Amendments Fizzle Amid GOP Defections

Posted on July 27, 2017 by David van den Berg, Dylan F. Moroses

A Senate proposal to partly repeal the Affordable Care Act fizzled July 26 after a group of Republicans defected, consigning it to the same fate as a plan the day before to repeal and replace much of the 2010 healthcare law.

Senate Finance Committee members Dean Heller, R-Nev., and Rob Portman, R-Ohio, were among seven Republicans who joined a united Democrat front to vote down the repeal bill 45-55 on July 26. It was one of many amendments offered to the House-passed American Health Care Act (AHCA, H.R. 1628) since the Senate narrowly approved opening debate on the measure.

Senators also defeated an amendment to send the AHCA to the Senate Finance Committee with instructions to remove language reducing or eliminating benefits or coverage for people eligible for Medicaid. That amendment died on a party-line vote.

The amendment to repeal and replace the ACA with the Better Care Reconciliation Act (BCRA), which was proffered late July 25, died 43-57. The latest iteration of the BCRAincluded proposals from Portman and Sen. Ted Cruz, R-Texas, which triggered a parliamentary requirement of 60 votes for passage. Portman’s proposal addressed states with expanded Medicaid programs and Cruz’s would have allowed states to approve insurance plans that do not meet the ACA’s essential minimum benefits as long as they offered one plan that did.

Sen. John McCain, R-Ariz., who indicated earlier July 25 that he would not vote for any iteration of the BCRA, ended up voting for it.

A Skinny Thread?

Lawmakers have suggested that a so-called skinny repeal bill could be put forward to remove the ACA’s employer and individual mandates and its tax on medical device manufacturers as a way to gather consensus among GOP senators. Such an option may present its own obstacles, but is not being ruled out by Senate Republicans.

Finance Committee member Tim Scott, R-S.C., told reporters that he would consider the proposal a “meaty bill, though it’s simple,” contending that it would yield almost $500 billion in savings by repealing the employer and employee mandates and industry-specific taxes, like the medical device excise tax.

Scott suggested passing such a measure would be a “major success.” However, others saw that approach as an obstacle. Going to conference and losing full control of what will ultimately be included in the healthcare bill is a “challenge,” Sen. Ron Johnson, R-Wis., told reporters.

Sen. Lindsey Graham, R-S.C., dismissed the idea of the House simply passing a “skinny” repeal measure after the Senate clears it when the topic was raised. “I won’t vote for that,” he said. “I think that’d be a joke.”

Sen. Lisa Murkowski, R-Alaska, noted that lawmakers are still trying to figure out what would be in a “skinny” repeal measure.

Rep. Mark Meadows, R-N.C., chair of the House Freedom Caucus, told reporters that if a “skinny” repeal measure were to clear the Senate, he doesn’t think that would be a way to reinsert the AHCA or the BCRA. Neither one, Meadows said, could return in conference “in their original form, so it would have to be some sort of a compromise.”

“I think it’s all about going to conference and finding a solution, and until we do, that there’s nothing that can be sent to the president,” he said.

Amendment Plans

Scott said that he offered an amendment early on in the bill negotiations, but is not sure whether he will do so again during the open amendment process following debate on the healthcare bill. He described his amendment as “a charity care amendment that was focused on providing [assistance] for liability exposure for physicians who want to get involved in healthcare in the nonprofit world.”

Senate Finance Committee Chair Orrin G. Hatch, R-Utah, told Tax Analysts that he will not have any amendments to offer to the healthcare bill, but remains uncertain whether the final reconciliation package will have enough support. “Your guess is as good as mine,” Hatch said.

Senate Minority Leader Charles E. Schumer, D-N.Y., announced late July 26 that Democrats would offer no further amendments until Senate Majority Leader Mitch McConnell, R-Ky., shows Democrats the final legislation to be voted on. He sharply criticized the amendment process, saying that since the debate started, senators have merely been voting to amend a dead bill.

Before that announcement, Democrats had said they planned to offer numerous amendments. Senate Finance Committee member Sherrod Brown, D-Ohio, told Tax Analysts he would be offering undisclosed amendments, but he added that he does not expect many tax-focused amendments considering the concerns surrounding the dramatic Medicaid spending reforms in the legislation and suggested that most Senate Democrats would focus their proposals on that program.